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Botulinum antitoxins and antibacterial IgM and IgG antibodies in sera of persons immunized with botulinum polytoxoid combined with cholera vaccine. I. Response to botulinum toxoid.

Two groups of subjects were immunized with combined vaccine containing aluminum hydroxide-adsorbed botulinum toxoids, types A, B, and E, and 4 mld of formaldehyde-inactivated V. cholerae Inaba and Ogawa organisms. The first group included laboratory workers who were previously immunized against cholera and had professional contact with botulinum toxins and viable V. cholerae organisms. The second group included young men who were never vaccinated against botulism or cholera. The three-dose immunization schedule with combined vaccine resulted in clear-cut antitoxin response; after the third dose, the A, B, and E antitoxin level ranged from 0-2 to 10 IU/ml. Immunity against botulinum toxins lasted at least one year. Distribution of the antitoxins among IgM and IgG globulin classes resembled that in the case of response to other toxoids; 21 days after the third immunization antitoxin activity was found in IgG globulins.

Adult

[1st stage of infectious allergy].

In administration of bacterial exotoxins (diphtheria, botulinic) to guinea pigs in doses of 1/100 Dlm at an interval of one hour there developed a typical sickness with the lethal outcome in the course of 2-3 days from the beginning of the exotoxin administration. Low bacterial exotoxin doses induced allergic reaction of the organism before the cell producing specific antibodies began to act in defence. Lymphatic system cells responded rapidly to the low doses of bacterial exotoxins, but the process of formation of cells producing antibodies failed to reach mature plasmocytes, and no antibodies formed. With increase of the interval between the administration of low bacterial exotoxin doses to 24 hours specific antibodies did form, but these antibodies failed to protect the animals which were in the state of infectious allergy. The first stage of infectious allergy induced by low bacterial doses was nonspecific. Animals which were in the state of infectious allergy to diphtheria exotoxin perished of low botulinic (exotoxin) doses, and vice versa.

Antibodies, Bacterial

Infant botulism.

Infant botulism is a unique neuromuscular disease affecting infants less than six months old. It is the result of intraintestinal toxin production by C. botulinum (toxi-infection). Characteristic symptoms include constipation, lethargy, and decreased feeding. Physical examination often reveals generalized hypotonia with cranial nerve impairment. Recovery is dependent on supportive care in an intensive care setting. The relationship of this disease to the sudden infant death syndrome requires further study.

Botulinum Antitoxin

A continuing common-source outbreak of botulism in a family.

In December, 1974, three cases of botulism occurred in a family; two were fatal. The first patient died after a 10-day illness without botulism being suspected. 4 days later, after a 2-day illness, the second patient was diagnosed as having botulism after a cardiorespiratory arrest; she died 3 days later. In the third patient, the only symptom was dysphagia. Clostridium botulinum type B was found in stool specimens from all three patients. Home-canned (bottled) mushrooms, which were found to contain C. botulinum type B and its toxin, were believed to be responsible for the outbreak; mushrooms were found at necropsy in the gastrointestinal tracts of both patients who died. Heat treatment of the mushrooms during canning had been inadequate.

Adult

Cultural and physiological characteristics of Clostridium botulinum type G and the susceptibility of certain animals to its toxin.

Strain 89 of Clostridium botulinum type G, isolated by Gimenez and Ciccarelli in 1969, was characterized culturally, biochemically, and toxigenically. It was motile, hemolytic asaccharolytic, weakly proteolytic, lipase and lecithinase negative, and it produced acetic, isobutyric, butyric, and isovaleric acids in peptone-yeast extract-glucose broth. No spores were seen in smears from solid or liquid media. Very low levels of toxin were produced in regular broth cultures, but dialysis cultures yielded 30,000 mouse 50% mean lethal doses (LD50 per kg, orally and subcutaneously, respectively; and for guinea pigs, 10,000 to 20,000 and 100 mouse LD50 per kig, intragastrically and intraperitoneally, respectively.

Animals

Phage conversion to hemagglutinin production in Clostridium botulinum types C and D.

Five toxigenic strains of Clostridium botulinum types C and D were incubated at 37 degrees C for 7 days in 15 ml of the following media: LYG medium, cooked-meat medium, egg meat medium, and N-Z-amine medium. The supernatants of these cultures were tested for hemagglutinin production with 1% erythrocytes obtained from mice, guinea pigs, chickens, sheep, monkeys, and humans. Four toxigenic strains produced hemagglutinin. The highest hemagglutinin titer was obtained with a combination of human erythrocytes and cultures incubated in LYG medium. When the same experiment was carried out with many nontoxigenic strains, hemagglutination was observed in only one strain, C-N71. Strains producing hemagglutinin also produced phages. The phages obtained from toxin- and hemagglutinin-producing strains converted nontoxigenic indicator strains to produce both toxin and hemagglutinin. The phage obtained from a toxin-positive hemagglutinin-negative strain could only induce cultures to produce toxin, and the phage from a toxin-negative hemagglutinin-positive strain could only induce production of hemagglutinin. These studies suggest that the production of hemagglutinin by C. botulinum types C and D is governed by bacteriophages and that hemagglutinin production can be transmitted separately or concomitantly with toxin production.

Bacteriophages

[Anaphylactogenic, antigeni and avid properties of the antibotulin serum from the blood of various animal species].

It was shown that purified and concentrated by the "Diaferm" method antibotulin sera from horse and cattle blood failed to differ by anaphylactogenic properties; at the same time in sensitization of the organism to protein of one animal species the use of the sera of another species provided a lesser reactogenicity of the preparation. The antigenic activity of the purified and concentrated sera from the blood or horses and cows in testing on rabbits was identical, but in response to cow alpha-globulin the animals responsed by a more intensive production of precipitins. The activity of cow and horse antibotulin serum (determined by the rate and stability of their association with the corresponding toxin) proved to be identical.

Anaphylaxis

Development of antitoxin with each of two complementary fragments of Clostridium botulinum type B derivative toxin.

Two fragments with molecular weights of 111,000 (fragment I) and 59,000 (fragment II) were separated from each other by gel filtration of dithiothreitol and urea-treated, trypsinized derivative toxin (molecular weight, 170,000) of the proteolytic Okra strain of Clostridium botulinum type B on a column of Sephadex G-200 (superfine) with a buffer containing dithiothreitol and urea. Upon removal of dithiothreitol and urea by dialysis, the two fragments reassembled to reconstruct the derivative toxin molecule. Both fragments were immunogenic, and both anti-fragments neutralized type B toxin. The neutralizing activities of both anti-fragment I and anti-fragment II were, however, lower than that of the anti-derivative toxin, suggesting that the molecular integrity of derivative toxin is essential for sufficient production of the neutralizing antibody. The immunological difference found between type B toxin from a proteolytic strain and that from a nonproteolytic strain was ascribed to the antigenic difference of fragment I.

Animals

Antitoxin responses to Clostridium botulinum vaccines types C and D in guinea pigs.

In guinea pigs, the type C and/or type D antitoxin responses to a single dose of a bivalent or monovalent Cl. botulinum vaccine increase markedly between the fourth and ninth week after injection and still increase markedly by the ninth week. For type C, a similar pattern has been found in cattle. Antigens of types C and D mutually interfere with the antitoxin responses in guinea pigs. Graded doses of vaccine arouse graded antitoxin responses in guinea pigs. Stability trials of vaccines have emphasized the unsatisfactory nature of an absolute-response type of assay, rather than revealing any loss of potency during storage. Attention is drawn to the need for a graded-response type of assay in which vaccines under test are compared with a reference vaccine.

Animals

An international survey of clostridial sera and vaccines.

The papers present the results of a survey of the usage, assay and specification of veterinary clostridial sera and vaccines in 23 countries. Thirteen of the countries use up to 8 different antisera. All the countries use vaccines, which are prepared from 13 species and types of clostridia. Vaccines containing up to 8 such components are commonly employed. Criteria for the design and interpretation of assays are discussed and evidence for efficacy summarized.

Animals

Type B botulism outbreak caused by a commercial food product. West Virginia and Pennsylvania, 1973.

In the week of May 7, 1973, seven persons contracted botulism after eating together. The most common symptoms were vomiting, constipation, dry mouth, dysphagia, and dysphonia. All were treated with trivalent botulinal antitoxin, and none died. Serum specimens obtained from all seven patients were negative for botulinal toxin, but stool specimens from three patients were positive for type B toxin. Electromyographic studies performed on five patients documented the neurophysiologic abnormalities of botulism. Commercially canned peppers in oil were implicated epidemiologically, and type B toxin was identified in leftover peppers. The processor voluntarily recalled the pepper product, and no further cases were reported.

Botulinum Antitoxin

Human-derived immune globulins for the treatment of botulism.

The need for a human-derived immune globulin to replace the equine antitoxins currently used in the treatment of botulism is well recognized. A small group of individuals who had received multiple immunizations with pentavalent botulinal toxoid were plasmapheresed for the purpose of collecting a botulism-immune plasma of human origin to be fractionated for the production of immune globulin. Human-derived immune globulin will offer the advantage over equine antitoxins of not inducing reactions to foreign protein and of having a prolonged effective half-life.

Animals

Botulism in Alaska, 1947 through 1974. Early detection of cases and investigation of outbreaks as a means of reducing mortality.

Since 1947, there have been 21 outbreaks of botulism in Alaska, involving 46 people with 13 deaths (28% fatality). In the last six months of 1974, there were four outbreaks. With one exception to date, type E toxin was involved in all outbreaks for which laboratory confirmation has been obtained, and in all instances, Eskimo and Indian foods were the source. Clinical signs and symptoms of nausea and vomiting, dysphagia, diplopia, dilated pupils, and dry throat occurred with great frequency, forming a diagnostic pentad. We recommend that treatment include close medical supervision, supportive care, and the use of antitoxin, cathartics, and possibly, penicillin. The source of an outbreak must be determined to prevent further cases. Only prompt recognition, therapy and epidemiologic investigation can reduce the death toll from botulism.

Adolescent